After Oprah Winfrey discussed her thyroid condition on her program last week, patient advocate and author Dr. Marie Savard was in demand by the media, and was seen on Good Morning America, discussing thyroid disease in women. Dr. Savard gave great, no-nonsense information, and I was glad to know she's out there offering sensible advice about thyroid disease. I've interviewed Dr. Savard before about thyroid disease, and she always has valuable information for patients. She is especially encouraging in that she provides guidelines and tools to help us advocate for ourselves in today's health care environment. If you haven't read her book How To Save Your Own Life, it's one of my favorites -- required reading for anyone who wants to ensure they receive the best possible health care.

I had the opportunity ask Dr. Savard a few questions today, which she graciously has answered for us. I know that women will find this information a valuable part of the continuing discussion about thyroid disease that Oprah launched last week.

Mary Shomon: Even Oprah Winfrey, a billionaire celebrity, had to gain 20 pounds, and go to multiple doctors for months, complaining of exhaustion and weight gain, before she was properly diagnosed. Why do you think it's so difficult for Oprah, and millions of other women in the U.S., to get properly diagnosed with thyroid conditions?

Marie Savard, MD: It is an extraordinary story but really all to common that even the most prominent and outspoken people such as celebrities and physicians don't necessarily get the best health care when it comes to diagnosing and treating thyroid disease. Often women are too quick to write their symptoms off to stress and overwork and barely volunteer to their doctors what is really going on and how they feel. Doctors may assume someone else checked all the blood work for thyroid disease or they may only check the most basic of screening tests for thyroid and not check a complete thyroid profile. That is why I am so passionate about women taking charge of their own thyroid health by 1) preparing for each and every doctor visit by researching their signs and symptoms on their own (thank you Mary Shomon for your extraordinary information and ability to communicate clearly and loudly to women about thyroid disease), 2) reviewing their symptoms and findings with a friend or "health buddy," preparing an agenda listing at least 2 to 3 of your most pressing questions and bringing your healthy buddy with you to the doctor visit; this friend can take notes, speak up if you are afraid to, jot down what the doctor's findings are, 3) keep an original copy of all of your medical test results in a folder and making that information available to every doctor you see; give your doctor a self-addressed stamped envelope as a quick reminder and 4) review your test results, ask questions, do more research to learn all you can about what exactly may be going on.

Developing thyroid disease is a process that rarely happens overnight. Often your blood tests might fluctuate and at times be read as normal when in fact your symptoms are indeed from a developing thyroid problem. So you may need to have your tests repeated at some point and compared to your previous ones. I remember a patient who to this day thanks me for her large family with 5 kids!! She was undergoing treatment for infertility and just couldn't get pregnant. She came to me for a complete exam and told me she already had a complete blood check and didn't need it repeated. I insisted on a comprehensive blood profile and full thyroid tests and sure enough she was severely hypothyroid. No one had thought to question what blood tests she had previously or to review her records. Once she was treated with thyroid hormone she quickly became pregnant. What a waste of time, medical testing, and expense - a simple review of her entire medical history and the missing thyroid information quickly led me to the right diagnosis. Never assume because your doctor said you had "complete" blood work that everything important was tested. Always ask for a copy of your test result information and review it yourself.

Mary Shomon: Sometimes, women go to their doctors with symptoms such as hair loss, fatigue, weight gain, and such, but doctors dismiss them, saying that they just need to stop eating so much, get more rest, or eliminate stress. Sometimes, these women are even given antidepressant prescriptions, instead of thyroid lab tests. How can a woman who finds herself in this situation be taken seriously, and receive proper medical care?

Marie Savard, MD: You are so right!! In fact I would say the same thing about women and heart disease. Research has shown that when women complain of chest pain they are more likely to be given a prescription for tranquilizers than to have the necessary heart testing. Studies have shown that as women we are often "profiled" by our doctors who often attribute our symptoms to stress and caregiving. There is no question that stress and the responsibility of raising a family or caring for elderly parents (I am doing that right now) can lead to a variety of problems - but many of those problems require evaluation and treatment. Yes, more sleep, paying attention to our own needs, etc. is obviously very important. But at the end of the day, we need to consider all possible causes of our problems and address whatever we can as proactively as possible. The fact we take the time to make an appointment with our doctors to explore what is going on already says that we believe our symptoms are caused by something more than the stress we already know we have in our life.

I would emphasize that to be taken seriously at your next doctor visit you need to be proactive: Prepare for the visit so that you come armed with specific informed questions at the time of your visit, bring your health buddy or advocate with you (YES - she comes in the exam room too), inform your doctor that you want to be proactive and that you need the peace of mind that only a thorough check up will give. Finally ask ALWAYS for copies of test results.

Mary Shomon: Do you feel that the the philosophy of health that says that thyroid problems develop due to women's inability to express themselves might somehow make it more difficult for women -- who go to a doctor complaining of weight gain, fatigue, low sex drive, or mood swings -- to get properly evaluated and treated for thyroid disease?

Marie Savard, MD: You hit the nail on the head!! My concern after watching Oprah's discussion is that women will just write off their symptoms to stress and not take the necessary steps to get to the bottom of what is going on. I do think that to simply use "stress" as the catch-all for every complaint a woman has is totally unfair and even dangerous. I am convinced that we need to trust our own health radar for ourselves and our family, take steps to minimize stress as much as we can (I need 7-8 hours of sleep and for me this is the number one way to keep my immune system strong and my health good), BUT at the same time, if we feel something is not right, is out of the ordinary - we must believe it and act on it. We don't need our doctors to simply remind us of our stress, we need our doctors to carefully review our entire medical history and consider and test us if necessary for all the treatable conditions we may have. Finally - one set of test results is great but we may need to monitor them or compare them to future results. Thyroid disease is a dynamic process and a single blood test may not give the complete picture.

Read all of Mary Shomon's About.com Thyroid site coverage of Oprah Winfrey's thyroid condition here.

For more from Dr. Savard, read Tips on Managing Your Own Thyroid Disease and Health Information: Marie Savard, MD on How Information May Save Your Life, or visit her website, Dr. Marie's Healthy Dose, at www.drsavard.com.

_{Photo courtesy Marie Savard, MD}